4564 Federal Register / Vol. 77, No. 19 / Monday, January 30, 2012 / Notices 

Desk Officer. Fax Number: (202) 395– 

6974. 

Email: 

OIRA_submission@omb.eop.gov. 

Dated: January 24, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–1945 Filed 1–27–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–855I and CMS– 

855R] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare & Medicaid 

Services (CMS) is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this burden 

estimate or any other aspect of this 

collection of information, including any 

of the following subjects: (1) The 

necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions; 

(2) the accuracy of the estimated 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

1. Type of Information Collection 

Request: Revision of a currently 

approved collection. Title of 

Information Collection: Medicare 

Enrollment Application for Physician 

and Non-Physician Practitioners. Use: 

Health care practitioners who wish to 

enroll in the Medicare program must 

complete the CMS 855I enrollment 

application. It is submitted at the time 

the applicant first requests a Medicare 

billing number. The application is used 

by the Medicare Administrative 

Contractor (MAC), to collect data to 

assure the applicant has the necessary 

professional and/or business credentials 

to provide the health care services for 

which they intend to bill Medicare 

including information that allows the 

MAC to correctly price, process and pay 

the applicant’s claims. It also gathers 

information that allows the MAC to 

ensure that the practitioner is not 

sanctioned from the Medicare program, 

or debarred, suspended or excluded 

from any other Federal agency or 

program. Form Number: CMS–855I 

(OCN 0938–0685). Frequency: Once and 

Occasionally. Affected Public: Private 

Sector (Business or other for-profit and 

not-for-profit institutions). Number of 

Respondents: 345,000. Total Annual 

Responses: 345,000. Total Annual 

Hours: 824,000. (For policy questions 

regarding this collection contact 

Kimberly McPhillips at (410) 786–5374. 

For all other issues call (410) 786–1326.) 

2. Type of Information Collection 

Request: New collection. Title of 

Information Collection: Medicare 

Enrollment Application—Reassignment 

of Medicare Benefits. Use: Health care 

practitioners who wish to reassign their 

benefits in the Medicare program must 

complete the CMS 855R enrollment 

application. It is submitted at the time 

the physician or non-physician 

practitioner first requests reassignment 

of his/her Medicare benefits to a group 

practice, as well as any subsequent 

reassignments or terminations of 

established reassignments as requested 

by the physician or non-physician 

practitioner. The application is used by 

the Medicare Administrative Contractor 

(MAC) to collect data to assure the 

applicant has the necessary information 

that allows the MAC to correctly 

establish or terminate the reassignment. 

Form Number: CMS–855R (OCN 0938- 

New). Frequency: Occasionally. 

Affected Public: Private Sector (Business 

or other for-profit and not-for-profit 

institutions). Number of Respondents: 

100,000. Total Annual Responses: 

100,000. Total Annual Hours: 50,000. 

(For policy questions regarding this 

collection contact Kimberly McPhillips 

at (410) 786–5374. For all other issues 

call (410) 786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web Site 

address at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office at (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by March 30, 2012: 

1. Electronically. You may submit 

your comments electronically to 

http://www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number llllRoom C4–26– 

05, 7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: January 24, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–1951 Filed 1–27–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9970–NC] 

Request for Information Regarding the 

Reinsurance Program Under the 

Affordable Care Act 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Request for information. 

SUMMARY: This notice is a request for 

information (RFI) to gain market 

information on entities that could 

administer a transitional reinsurance 

program. This RFI will inform one or 

more future Requests for Proposals 

(RFP). This RFI solicits information 

about entities that could function as a 

reinsurance entity for the transitional 

reinsurance program. CMS or one or 

more States may contract for services 

required to fulfill the statutory and 

regulatory requirements of the 

reinsurance entity. 

DATES: Submit written or electronic 

comments by February 29, 2012. 

ADDRESSES: In responding, please refer 

to file code CMS–9970–NC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit responses in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 


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